gms | German Medical Science

Background: Advanced and resectable larynx and hypopharynx squamous cell carcinomas are , in the vast majority of cases, treated by surgery and postoperative irradiation. Some institutions prefer to use irradiation and reserve radical surgery for salvage.The most frequent larynx preservation approach consists in the combination of irradiation and platin based chemotherapy. Induction chemotherapy followed by irradiation in good responders or by surgery in poor responders is the classic larynx conservation approach based on two large multicenter studies in the United states and Europe [Ref. 1], [Ref. 2]. Comparing with radical surgery followed by irradiation this strategy did not jeopardize survival and allowed larynx preservation in 50% to 66% of survivors. New aspects of this treatment form are the combination of induction chemotherapy followed by concomittant radiochemotherapy.

We perform a multicenter study which compares two treatment strategies: induction chemotherapy with cisplatin, 5-Fluouracil and docetaxel followed by radiochemotherapy with cisplatin in one arm with the same induction chemotherapy regimen followed by surgery and radiotherapy in the other arm.

Results: The first results with 60 patients with an advanced locally cancer of larynx or hypopharynx underwent a multimodal treatment with a triple chemotherapy regimen (3 cycles 75mg/qm taxotere, 100mg/qm cisplatin and 4000mg/qm 5-Fluouracil every three weeks) and the following chemoradiation (standard fracination with 70 Gy +100 mg/qm cisplatin every three weeks) show an overall response rate of 73% with a complete remission rate of 45%.

In summary, we predict that this form of multimodal treatment will accomplish a major change in prognosis and quality of life in patients with locally advanced SCC in head and neck and is a prognostic test for more aggressive treatment.